When it comes to neck pain, surgery is usually a last resort. Doctors try medicine, physical therapy, and other treatments before suggesting an operation. But it might be the right choice if your condition is really painful or causing problems in your arms and legs.
Neck pain is often because of wear and tear on the shock-absorbing discs that sit between the vertebrae, which are bones in your neck.
As you age, discs can get weak, bulge, or rupture. They can “pinch” a nerve root or compress the spinal cord. The vertebrae can wear out too and develop bone spurs which can press on the spinal cord or nerves.
Should You Get Surgery?
Your doctor may suggest an operation if you have:
- Trouble with balance or walking
- Fine-motor problems (trouble buttoning a shirt or tying your shoes, for example)
- Pain or numbness in your arms
- Tingling in your hands or fingers
What Are Your Choices?
If you have a pinched nerve, these are the most common operations to relieve the pain:
Anterior cervical discectomy with fusion (ACDF): The surgeon enters your neck from the front (anterior) and takes out the damaged disc and any spurs. A piece of bone (either from you or a donor) is placed in between the vertebrae. The two bones are held together using metal plates, screws and rods. Within a few months, the vertebrae should grow together into one solid bone (fusion). Your neck will be a little less flexible afterwards.
Artificial disc replacement: This approach is similar to ACDF except your disc is replaced with a man-made one instead of a piece of bone. There’s no fusion, so you’ll have better range of motion in your neck.
Posterior cervical laminoforaminotomy: You lie face down on the operating table for this operation. Your surgeon makes a small cut in the back (posterior) of your neck. They use special tools to open up the bony arch on the back side of your spinal canal called the lamina. This allows them to get at your damaged nerve more easily. They then take out whatever is pinching it. No bones are fused together.
If your spinal cord is compressed, your surgeon may suggest ACDF or another type of surgery.
Anterior cervical corpectomy with fusion: This is similar to ACDF -- but your surgeon removes a vertebra and any other tissue or bone that causes pressure. Your spine will be stabilized with fusion.
These operations on the lamina are posterior and often need spinal fusion:
Laminectomy: Your surgeon will remove the lamina. They’ll take out any spurs or ligaments that are on the cord. This operation relieves pressure by making more space within the spinal column.
Laminoplasty: This surgery doesn’t remove the lamina. Instead, it’s thinned out on one side and then cut on the other. This creates a hinge, like on a door. That makes more room for your spinal cord.
Your doctor may use a combination of anterior and posterior techniques, depending on your situation.
What Are The Complications?
You run the risk of infection or a bad reaction to anesthesia with any kind of surgery. The risk of complications goes up if you’re elderly, have diabetes, or lots of medical problems.
Specific problems with spinal surgery include:
- Nerve or spinal cord damage
- Injury to the esophagus (food tube)
- Voice changes
Sometimes, surgery doesn’t work. Your doctor will tell you about your chances of success and how likely it is that you’ll have complications.
What’s Recovery Like?
- You’ll probably stay in the hospital a day or two.
- You should be able to walk and eat the first day after surgery.
- If you get anterior surgery, you may have trouble swallowing solid food for a few weeks.
- Your surgeon may put a drain in your neck to collect blood and fluid after the operation.
- You may need to wear a neck collar for support.
With spinal fusion, it can take up to a year for the bones to heal and become solid. Your doctor may recommend only light activity -- like walking -- for some time.
Depending on your surgery, you may need physical therapy.
You might be able to return to work at a desk job in a few days or a few weeks. Your doctor will tell you what to expect so you can arrange for time off.